Provider Demographics
NPI:1912333485
Name:WHITE, MATTHEW DAVID (BCBA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DAVID
Last Name:WHITE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 ROSEWOOD AVE.
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221
Mailing Address - Country:US
Mailing Address - Phone:804-513-2550
Mailing Address - Fax:804-378-6183
Practice Address - Street 1:3207 ROSEWOOD AVE.
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221
Practice Address - Country:US
Practice Address - Phone:804-513-2550
Practice Address - Fax:804-378-6183
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst